GUM: STIs Flashcards

Question

Questions to ask with patient presenting with discharge?

Answer 1

Further info on the discharge * Colour * Odour * Consistency * Bloodstaining Other symptoms: * associated itch or soreness * Intermenstrual/ post-coital bleeding * Dysparaunia * Gential rash/ lesions Sexual Histroy

Answer 2

**Physiological** * pregnancy * sexual arousal * Menstrual cycle variation **Pathological: Vaginal** * Candidosis * Trichomoniasis * Gardenerelia associated * other bacteria e.g. due to a foregin body * Post menopausal vaginitis **Pathological: Cervical** * Gonorrhoea * Non-specific genital infection * Herpes * Cervical ectopy * Cervical neoplasm e.g. polyp

Answer 3

Examination (incl vaginal pH) High vaginal swab: * culture for T.vaginalis, candida spp * Wet mount * Gram stain Vulvovaginal swab * NAAT for N. gonorrhoeae and C. trachomatis Endocervical * Gonorrhoea culture Other tests * Culture for other organisms if relevant * HSV PCR from cervix

Answer 4

* Immunosuppression (HIV, steroids, chemotherapy) * High oestrogen levels (pregnancy, luteal phase, some COCs) * Recent Abx * DM * Mucosal breakdown (sexual contact, dermatitis) * Recurrent candidiasis ?associated with atopy

Answer 5

Fluconazole 150mg stat or Clotrimazole 500mg pessary PV stat Clotrimazole 1% (+/- hydrocortisone 1%) cream top BD for 2 weeks NICE Clinical Knowledge Summaries recommends: * oral fluconazole 150 mg as a single dose first-line * clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated * If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal * if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated

Answer 6

Hay-Ison- based on gram- stained smear of swab from posterior vaginal fornix Amsel Criteria- 3 of any of the following 1) characteristic discharge 2) Clue cells on wet mount-epithelial cells 3) Raised pH 4) Odour with KOH ('whiff test')

Answer 7

* Describes an overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis. * Leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH. * NOT STI- but seen almost exclusively in sexually active women

Answer 8

oral metronidazole for 5-7 days- 400mg BD 70-80% initial cure rate relapse rate > 50% within 3 months the BNF suggests topical metronidazole or topical clindamycin as alternatives

Answer 9

Results in an increased risk of preterm labour, low birth weight and chorioamnionitis, late miscarriage Recent guidelines recommend that oral metronidazole is used throughout pregnancy.

Answer 10

highly motile, flagellated protozoan parasite STI

Answer 11

* Vaginal discharge: offensive, yellow/green, frothy * Vulvovaginitis * Strawberry cervix * pH >4.5 * Usually asymptomatic in men but may have urethritis

Answer 12

Sample sites- posterior fornix, self taken vulvo-vaginal swab Urethra/centrifuged first void urine in men Wet mount: 70% sensitive compared to culture degrades over time. shows motile trophozoites

Answer 13

400mg BD oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole

Answer 14

Examination Gram-stained smear from urethra (having held urine)- gram negative intracellular diplocci (working diagnosis of gonorrhoea) if polymorphonuclear leucocyte and no Gram -ve non-gonoccal urethritis. Gonorrhoea culture- if clinically suspicious First catch Urine NAAT for gonorrhoea and chlamydia Consider: microscopy of urine threads, wet smear for TV, MSU, herpes simplex PCR

Answer 15

Gonococcal urethritis Non-specific urethritis

Answer 16

STIs: * Chlamydia tachomatis (> 60-70%) * Mycoplasma genitalium * Ureaplasma urealyticum * Trichomonase vaginalis * Herpes simplex * HPV

Answer 17

Most prevalent STI Obligate intracellular pathogen Incubation period is around 7-21 days

Answer 18

asymptomatic in around 70% of women and 50% of men women: cervicitis (discharge, bleeding), dysuria men: urethral discharge, dysuria

Answer 19

epididymitis pelvic inflammatory disease endometritis increased incidence of ectopic pregnancies infertility reactive arthritis perihepatitis (Fitz-Hugh-Curtis syndrome)

Answer 20

NAAT is the investigation of choice for women: the vulvovaginal swab is first-line for men: the urine test is first-line urine (first void urine sample), vulvovaginal swab or cervical swab may be tested using the NAAT technique Testing should be carried out 2 weeks after first exposure

Answer 21

in England the National Chlamydia Screening Programme is open to all men and women aged 15-24 years t he 2009 SIGN guidelines support this approach, suggesting screening all sexually active patients aged 15-24 years relies heavily on opportunistic testing

Answer 22

**drug therapy** * First line: Doxycycline 7 days * if doxycycline is contraindicated azithromycin (1g od for one day, then 500mg od for two days) should be used * if pregnant then azithromycin, erythromycin or amoxicillin may be used. The SIGN guidelines suggest azithromycin 1g stat is the drug of choice 'following discussion of the balance of benefits and risks with the patient' **Partner contact ** * offered a choice of provider for initial partner notification - either trained practice nurses with support from GUM, or referral to GUM * Men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms * Women and asymptomatic men all partners from the last six months or the most recent sexual partner should be contacted * contacts of confirmed Chlamydia cases should be offered treatment prior to the results of their investigations being known (treat then test)

Answer 23

* Gram-negative diplococcus Neisseria gonorrhoeae * occurs on any mucous membrane- usually GUM but also rectum and phayrnx * Incubation period 2-5 days

Answer 24

males: urethral discharge, dysuria females: cervicitis e.g. leading to vaginal discharge rectal and pharyngeal infection is usually asymptomatic

Answer 25

antigen variation of type IV pili (proteins which adhere to surfaces) and Opa proteins (surface proteins which bind to receptors on immune cells)

Answer 26

Uretheral strictures Epididymitis Salpingitis (may lead to infertility) Disseminated infection Septic arthritis Endocarditis Perihepatitis

Answer 27

When antimicrobial susceptibility is not know: Ceftriaxone 1g IM (in 2ml 1% lidocaine) stat dose When antimicrobial susceptibility is known: ciprofloxacin 500mgs stat dose If ceftriaxone is refused (e.g. needle-phobic) then oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used

Answer 28

not fully understood but is thought to be due to haematogenous spread from mucosal infection (e.g. Asymptomatic genital infection)

Answer 29

tenosynovitis migratory polyarthritis dermatitis (lesions can be maculopapular or vesicular)

Answer 30

Unique. flask shaped, slightly curved organelle Smallest bacterium- Gram +ve ancestors Insensitive to Beta-lactams and emerging resistance to macrolides and quinolones

Answer 31

Recent partner changes Multiple contacts Recurrent symptoms Symptoms in partner Other symptoms: women: abdo pain, menstrual problems Men: Testicular pain Extragenital signs and symptoms of STI

GUM: STIs Flashcards

(55 cards)